JPAM Featured Article: "The Impact of Health Insurance on Preventive Care and Health Behaviors: Evidence from the First Two Years of the ACA Medicaid Expansions"

January 5, 2017 08:00 AM

As part of our ongoing effort to promote JPAM authors to the APPAM membership and the public policy world at large, we are asking JPAM authors to answer a few questions to promote their research article on the APPAM website.

By: Kosali Simon, Ph.D.; Aparna Soni; and John Cawley, Ph.D.

What was the genesis/history of the idea for your research?

When Kosali last visited Cornell we took a walk around the campus and discussed possible new projects on which we could collaborate. Kosali focuses on health insurance and I focus on risky health behaviors, so we thought it would be important and timely to study the impact of recent health insurance expansions on risky health behaviors like smoking, alcohol abuse, exercise, and obesity. From there, the project expanded to also examine the impacts on health insurance coverage, access to care, and use of preventive care.

What is the main conclusion that becomes evident from your research? (Or, what is our main takeaway?)

The main conclusion is that the state-level expansions of Medicaid that were facilitated by the ACA succeeded in some of their goals but not others. The expansions succeeded in expanding health insurance coverage, people’s access to medical care, people’s use of some forms of preventive care, and also improved self-assessed health. However, the expansions did not significantly increase use of other forms of preventive care, and did not seem to improve health behaviors. On the other hand, it did not worsen risky health behaviors either, which is important because ex ante moral hazard (people engaging in riskier activities once they have more insurance) was a concern.

What are some of the more interesting or surprising findings/conclusions, you discovered during this process?

The most policy-relevant aspects of the study are that the state-level Medicaid expansions facilitated by the ACA improved health insurance coverage and health care in several ways (e.g. increased the probability that individuals had health insurance, increased access to medical care, and increased use of preventive care) without creating problems of moral hazard (i.e. there is no evidence that people engaged in more smoking or alcohol abuse). What is particularly new in this study relative to the previous research literature are the findings that the Medicaid expansions increased certain forms of preventive care and apparently resulted in no moral hazard with respect to risky health behaviors; both are new findings with respect to the 2014 Medicaid expansions, and previous studies of these questions using earlier health insurance expansions tended to find mixed results. We also confirm an important earlier finding that the 2014 Medicaid expansions resulted in improvements of self-assessed health.

Authors' Bio

Kosali Simon (@KosaliSimon) is a Professor in the School of Public and Environmental Affairs at Indiana University and a Research Associate of the National Bureau of Economic Research (NBER). In 2016 she was also named a Class of 1948 Herman B Wells Endowed Professor, becoming only the third recipient of this honor at Indiana University. Her primary research area is applying economic analysis in the context of health insurance and health care policy, and her current main research focus is the impact of the Affordable Care Act on healthcare and labor market outcomes. She is the 2007 recipient of the John D. Thompson Prize for contributions to health services research, and in 2013, she was selected to the National Advisory Committee of RWJF Health Policy Scholars Program. She is a Board Member of the American Society of Health Economists and the American Economic Association (AEA)'s Committee on the Status of Women in Economics (CSWEP). Kosali is an associate editor of the Journal of Health Economics and of Health Economics, and an editorial board member of the American Journal of Health Economics and the Journal of Policy Analysis and Management. Prior to joining Indiana University, she was an Associate Professor at Cornell University. She received her Ph.D. in Economics from the University of Maryland at College Park.

Aparna Soni (@AparnaSoni7) is a doctoral candidate in the Department of Business Economics and Public Policy at Indiana University, Kelley School of Business. She is interested in applying economic principles and econometric analysis to the field of health policy and health care reform. Her current research focuses on the impacts of health insurance on consumers' health behaviors and purchasing patterns. In 2016, she received the Kelley School of Business Research Productivity Award for doctoral students and was nominated for the Panschar Teaching Award. Prior to joining Indiana University, Aparna worked as an economist at IHS Global Insight and as an analyst at the US International Trade Commission. She received her M.A. in economics and B.A. in economics and journalism from Boston University, where she was a recipient of the Trustee Scholarship for academic excellence.

John Cawley (@Cawley_John) is a Professor in the Department of Policy Analysis and Management, and the Department of Economics, at Cornell University. He is co-Director of Cornell's Institute on Health Economics, Health Behaviors and Disparities. In addition to his affiliation with Cornell, John is a Visiting Professor at the School of Economics of the University of Sydney, Australia, an Honorary Professor at the J.E. Cairnes School of Business and Economics at the National University of Ireland, Galway, and a Research Associate of the National Bureau of Economic Research (NBER). His research focuses on the economics of risky health behaviors; in particular, those that relate to obesity. John has received the Investigator Award in Health Policy Research from the Robert Wood Johnson Foundation, the State University of New York (SUNY) Chancellor's Award for Excellence in Scholarship, the John D. Thompson Prize for Young Investigators, the Charles C. Shepard Science Award in Prevention and Control from the Centers for Disease Control and Prevention, and served as a Fulbright Specialist in Economics to Ireland. Prior to arriving at Cornell, John was a Robert Wood Johnson Foundation Scholar in Health Policy Research at the University of Michigan. He received his Ph.D. in economics from the University of Chicago and his undergraduate degree in economics from Harvard University.

Check out this and other Journal of Policy Analysis and Management articles online.